By Kyla Demers
The public is becoming increasingly aware of the serious risks that concussions pose. At the same time, researchers and concussion specialists are learning just how complex mTBIs can be, as well as how greatly they can impact long term health. It’s clear that we need further research, better tools, and more integrated treatment approaches to provide advanced concussion care for the millions of people who suffer them each year.
A Multi-Disciplinary Approach
Concussion patients don’t have a lot of tools or services offered to them in the public sector. Which is why at Vertex Concussion, we want to make sure that any services that are needed can be accessed whenever they are needed. Concussions are complex, and every case is unique, so we need to incorporate expertise and a network of specialists in every domain of care that’s relevant.
Our goal has been to build up a complete rehab team, so we can treat every aspect of concussions based on what the latest research tells us is necessary. This is critical, because too often patients only receive proper therapy for one aspect of their condition, but it’s not enough. Concussion management is not just one scope, it’s a whole spectrum where everything needs to be addressed.
In particular, visual, vestibular and proprioception systems all have to work together. If any of these systems are off, then they’re going to cause problems at a wider level. You need every piece of the puzzle back in place to avoid recovery being prolonged.
We also go beyond rehabilitation by covering prevention and education. This includes providing courses to athletes, teams, schools and the general population. When a brain trauma happens, it’s important for people to know what to do.
At the Outset of Care
Our first evaluation with a patient involves reviewing their medical history to check for predisposing factors, understanding the mechanism of injury, and then assessment of the vestibular, visual and motor functions, as well as the head and neck. Any major problems that could hinder the overall rehab process are prioritized at the outset, for correction with an appropriate specialist.
Throughout the course of therapy we give guidance on daily activities to help patients avoid chronic fatigue, yet still get enough safe activity to help with recovery. For example, for an athlete this could mean prescribing light aerobic exercise, and making sure they don’t attempt any sports until we know they are ready.
In and out of the clinic, knowing the right timing for when and when not to progress therapy is essential. If therapy is progressed too quickly it can bring back symptoms and cause setbacks. For example, we’ve seen people coming in from other treatments and activities that were too advanced, and as a result they struggled with post-concussion symptoms as their condition became chronic.
The Role of Vision
A major factor in concussion rehabilitation is vision, which can play a huge role in both symptoms and recovery. Vision represents around 70-80% of all our sensory processing, and with mTBIs, any excess visual stimulation can cause peripheral vision to shut down. This effect is known as ‘tunnel vision’, which can provoke all kinds of post-concussion symptoms. When this happens, patients tend to be afraid of things that stimulate their peripheral vision, such as being in public areas, so they often shut down and isolate themselves off in their homes.
What we do at the beginning of therapy is gently start to teach patients to soften and relax their gaze. Usually this is just some simple exercises, such as relearning how to be aware of their environment, such as the room around them, but without directly looking at objects. From there we need to move onto more advanced forms of therapy.
We’re very keen at Vertex Concussion on developing the whole aspect of vision therapy. My goal over the past year has been to research and discover all the potential therapies we can offer patients. This winter I went to a concussion course and was introduced to NeuroTracker. Right away it seemed to me a really good rehabilitation tool that would help me evaluate a person’s cognitive state.
We have a lot of subjective assessments in concussion therapy, but this is a tool which can objectively tell where a patient is, and it’s great for the patient because they get to see and understand how they are doing. It also offers us a chance to provide an effective at-home therapy program, which we can monitor remotely.
Training Spatial Awareness
Most importantly, NeuroTracker has become a core tool for us to be able to recover visual systems, in both a controlled and progressive manner. We start with training and assessment early on, once any critical symptoms have stabilised. We want to do this in order to train spatial awareness, and prevent patients falling into tunnel vision.
It’s not a question of processing speed, it’s a question of getting their brains to be able to perceive the environment, so they start to adapt to real-world stimuli. With just 15 minutes sessions each visit, within the course of overall therapy, we steadily see the patient’s ability to perceive environmental stimuli start to come back.
The goal of NeuroTracker training is to improve attention, concentration and focus, so I can see how this tool fits well with different populations. In particular it’s great for athletic performance, where the mental aspects of sports are just as important as the physical aspects, and in fact overlap.
With this in mind we sometimes put athletes on NeuroTracker in different positions they need to be in for their sport. To give an example, we had a hockey player recovering from concussion who was progressing well. However, when we introduced puck handling skills while NeuroTracking, he quickly starting losing his postural control. This signified that if he went out and played under pressure, he would be vulnerable to getting another hit. In this way we had a performance readiness assessment which showed us precisely what we needed to work on.
When it comes to aging populations, vision and vestibular systems naturally deteriorate as we get older, which is something we see in our clinic. Here, NeuroTracker is a nice tool for stimulating neuroplasticity to try to help older patients retain their independence for as long as possible. This can also include preventing risk of injury, because if vision and balance is improved, older people are less likely to a fall and get serious injuries like fractures.
I can also see how NeuroTracker could be a really good tool for kids, teenagers and academics, to help them sustain their concentration and focus for longer periods of time. It would be ideal to see more concussion tools like this become available, so we that can go beyond actual therapy, and help with life-based skills after recovery.
About Kyla Demers
Kyla holds degrees in Osteopathy and Athletic Therapy. She began her career in Sports Medicine while working with the provincial teams of Rugby Quebec and has been part of the medical team at the Canada Games twice, and at the Vancouver Olympics. She has also been a consultant for the Armada (QMJHL). Kyla is an Osteopath for Osteo & Cie and pioneers new therapies at Vertex Concussion.
A rugby and hockey player, Kyla oversees the treatment of several cases of concussion by providing a thorough assessment and a return to safe and healthy activity. Since 2016, she has worked rigorously on a research project at Concordia University to investigate links between the restrictions of mobility of the neck and head and the persistent symptoms associated with a concussion. The goal is to improve the care available to people with concussions and post-concussive symptoms.
If you’re interested in learning more about the latest treatment practices for concussion management, then check out this blog by Shift Concussion Management.
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